Duodecim; Laaketieteellinen Aikakauskirja[JOURNAL]
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200 papers
[Macrophages and cancer].
Salmi M
Duodecim · 2017 · PMID 29239591
Macrophages are an important type of white blood cells in the dialogue between inflammatory response and cancer. Macrophages can maintain a chronic inflammatory state that predisposes to the development of cancer. In the...
Macrophages are an important type of white blood cells in the dialogue between inflammatory response and cancer. Macrophages can maintain a chronic inflammatory state that predisposes to the development of cancer. In the tumor, macrophages phagocytose and kill cancer cells directly and promote the generation of antitumoral cytotoxic lymphocyte response. Cancer cells, however, often modulate the functions of macrophages in several ways to promote tumor progression. Such protumoral macrophages increase neovascularization, produce molecules promoting the growth and dissemination of cancer cells, and suppress antitumoral immune responses. Hence, abundant macrophage infiltration correlates with poor prognosis in most types of cancer. Many cancer treatments also affect the antitumoral properties of macrophages. New drugs are developed to reduce the accumulation of macrophages into malignant tissue and to re-educate pro-tumoral macrophages to anti-tumoral macrophages and some of these drugs have already entered clinical trials.
How to help patients adopt and maintain a healthy lifestyle? A review of behavioral evidence of determinants and means.
Absetz P, Hankonen N
Duodecim · 2017 · PMID 29239585
A significant part of the population do not follow dietary and exercise recommendations. In Current Care Guidelines, lifestyle counseling is considered as part of good medical care. Lifestyle diseases are, however, not d...
A significant part of the population do not follow dietary and exercise recommendations. In Current Care Guidelines, lifestyle counseling is considered as part of good medical care. Lifestyle diseases are, however, not decreasing. Does counseling fail to reach its goal, or is it being provided at all? In the narrative review article based on systematic surveys, we approach the change in lifestyle through both conscious and automatic psychosocial processes. Research evidence indicates that a change in behavior can be supported through both processes. While intervention studies have been so far conducted mainly by influencing conscious processes, evidence of benefits of using automated processes is growing stronger. We present practical measures to support the desire for change and skills and establishments of habits. The same methods may in part be utilized to change professionals in their own behavior so that provision of quick and simple lifestyle counseling becomes a matter actualized in everyday life.
Children's rights and the possibilities of health promotion in early childhood.
Kurttila T
Duodecim · 2017 · PMID 29239584
National and international research evidence of the importance of early childhood and early childhood education to human well-being, resilience and attachment to the society justifies the investment in childhood and chil...
National and international research evidence of the importance of early childhood and early childhood education to human well-being, resilience and attachment to the society justifies the investment in childhood and children. From the society, this requires national intent, management by knowledge, and strengthening of fundamental rights of children.
Social media in the promotion of health.
Matikainen J, Huovila J
Duodecim · 2017 · PMID 29239583
Social media has brought about a major change in communication. Besides ordinary people, the change applies to organizations and public authorities. In the social media, the public becomes an active player and content pr...
Social media has brought about a major change in communication. Besides ordinary people, the change applies to organizations and public authorities. In the social media, the public becomes an active player and content provider. With social media, communication will become increasingly media-centered. The change in communication scenery has challenged traditional expertise. On the other hand, social media also opens up many possibilities for the establishment of expertise and health communication. Within the social media, communities can become significant sites for the production of knowledge and expertise. They may generate useful activity as regards the combination of health information activities and everyday life, but sometimes they can also become a cradle of false information. In its various forms, social media provides a versatile forum for health communication, where people can be met interactively.
Health promotion among the population of foreign origin in Finland involves special issues.
Castaneda AE, Kuusio H, Skogberg N … +7 more , Tuomisto K, Kytö S, Salmivuori E, Jokela S, Mäki-Opas J, Laatikainen T, Koponen P
Duodecim · 2017 · PMID 29239582
The population of foreign origin in Finland is a heterogenic group, diverse for example with respect to reasons for and age at migration. While migration to Finland is a recent phenomenon, the size of the population of f...
The population of foreign origin in Finland is a heterogenic group, diverse for example with respect to reasons for and age at migration. While migration to Finland is a recent phenomenon, the size of the population of foreign origin has grown rapidly and will continue to increase. Changes in the population structure need to be taken into account in health promotion. For example lifestyle, health status, functional capacity, mental health, infectious diseases and reproductive health differ in foreign origin population compared with the general Finnish population. These differences may provide opportunities but also create challenges for service provision and health promotion planning.
Promotion of mental health in the core of public health work.
Wahlbeck K, Hannukkala M, Parkkonen J … +2 more , Valkonen J, Solantaus T
Duodecim · 2017 · PMID 29239580
Positive trends achieved in health in Finland are not equally reflected mental health, hence mental health promotion deserves a central position. Mental health promotion refers to strengthening of psychological resources...
Positive trends achieved in health in Finland are not equally reflected mental health, hence mental health promotion deserves a central position. Mental health promotion refers to strengthening of psychological resources, and has been linked to increased well-being and life satisfaction. Health care has an important role in supporting a solid foundation of mental health and in preventing intergenerational transmission of problems. Mental health promotion requires strong involvement of non-health sectors. There are means for strengthening mental health skills also on the individual level. The gap between existing evidence on effectiveness and cost-effectiveness of mental health promotion and the lack of large scale implementation needs to addressed by future health and social policies.
National vaccination program - a success story of public health and economy.
Salo H, Kilpi T
Duodecim · 2017 · PMID 29239578
The savings in treatment costs generated by disease cases prevented by the national vaccination program exceed the costs of the vaccination program by at least 60 million euros. In addition, other costs due to contractin...
The savings in treatment costs generated by disease cases prevented by the national vaccination program exceed the costs of the vaccination program by at least 60 million euros. In addition, other costs due to contracting the illness are avoided. Vaccinations serve the purpose of both increasing well-being and releasing resources for other uses. Financial support of vaccinations through the health insurance system would be costly and targetted to those with the ability to pay. Public funds should be directed to the development of a vaccination program. New vaccines coming on the market are expensive. Adding a new vaccine to the vaccination program is based on scientific evidence-based expert assessments and cost-effectiveness. In addition to preliminary assessments carried out in support of decision-making, the National Institute of Health and Welfare monitors by using population-based health registers the effectiveness and cost-effectiveness of the vaccination program. From the standpoint of transparency of decision-making it would be preferred that the decision-makers define a willingness to pay threshold below which an intervention would be accepted and lead to funding.
Mechanical compression devices for cardiac arrest: report of three cases.
Varpula M, Simonen P, Nurmi J … +2 more , Lehtonen J, Tierala I
Duodecim · 2017 · PMID 29239577
Mechanical compression devices enable transportation of patients with cardiac arrest to the catheterization laboratory. Coronary angiography and coronary interventions can be performed while the patients are being resusc...
Mechanical compression devices enable transportation of patients with cardiac arrest to the catheterization laboratory. Coronary angiography and coronary interventions can be performed while the patients are being resuscitated with these devices. In this report, we describe three cases in whom resuscitation with mechanical compression devices and rapid transportation to the catheterization laboratory resulted in favorable cardiac and neurological outcome.
Living donor kidney transplantation.
Helanterä I, Honkanen E, Huhti J … +7 more , Isoniemi H, Jalanko H, Lempinen M, Miettinen M, Nordin A, Tertti R, Mäkelä S
Duodecim · 2017 · PMID 29239576
While the majority of kidney transplantations in Finland have been traditionally performed from deceased donors, the frequency of living donors should be increased. Kidney donation is a safe procedure for a carefully exa...
While the majority of kidney transplantations in Finland have been traditionally performed from deceased donors, the frequency of living donors should be increased. Kidney donation is a safe procedure for a carefully examined donor, and for the recipient living donation enables elective surgery and preemptive transplantation. Potential risks for the donor must be minimized, but according to current recommendations, mild hypertension or obesity are not absolute contraindications for donation. Guidelines for donor selection and examination have been updated to simplify the process for all parties. Legislation in Finland requires changes to optimize the use of all potential living donors.
DUI offenders may have multiple health and social problems - doctors play a central role in monitoring the use of medications affecting the central nervous system.
Karjalainen K, Lintonen T
Duodecim · 2017 · PMID 29239574
While the overall number of driving under the influence (DUI) cases has reduced, the proportion of drivers under the influence of medications or illicit drugs has increased. In studies based on Finnish register data sets...
While the overall number of driving under the influence (DUI) cases has reduced, the proportion of drivers under the influence of medications or illicit drugs has increased. In studies based on Finnish register data sets, the factors involved in DUI have been examined with the conclusion that drunk driving may be an indication of multiple health or social problems. According to several measures, DUI offenders who had used medications, especially benzodiazepines, were ill and disadvantaged. Doctors play a central role in reducing the number of DUI cases, e.g. by treating substance abuse problems and by monitoring the use of drugs which affect the central nervous system. It is possible that a DUI offender has accumulated a number of different problems at the same time, which is why the treatment of DUI offenders should pay attention to a comprehensive mapping of the situation and the use of multidisciplinary cooperation.
Current care guideline: Patient exposed to moisture damage.
Duodecim · 2017 · PMID 29206001
Moisture damages and dampness in buildings is a risk factor for respiratory symptoms and development of asthma. Diagnostics and care of the patients must be based on general guidelines, regardless of potential moisture d...
Moisture damages and dampness in buildings is a risk factor for respiratory symptoms and development of asthma. Diagnostics and care of the patients must be based on general guidelines, regardless of potential moisture damage in home or work place. No laboratory or other clinical tests exist that can be used to associate potential moisture damage to perceived symptoms of the patient. Buildings affected by moisture damages should be remediated, because it is likely to be beneficial to health of the occupants and other users and for the condition of the building.
Dislocation of cochlear implant magnet as a complication following MRI.
Murtojärvi S, Salonen J
Duodecim · 2017 · PMID 29206000
According to current best knowledge, an MRI scan can be performed for patients with cochlear implants. The warnings and recommendations of the implant manufacturers must be followed strictly to prevent complications, suc...
According to current best knowledge, an MRI scan can be performed for patients with cochlear implants. The warnings and recommendations of the implant manufacturers must be followed strictly to prevent complications, such as overheating, migration or demagnetization of the magnet in the implant. We report on a case of cochlear implant magnet dislocation as a complication for an MRI scan. The patient had a tight bandage around the head to hold the magnet in place as recommended by the manufacturer, but apparently the bandage was not in the correct place.
Treatment of acute Achilles tendon ruptures in Central Finland Central Hospital in 2010-2015.
Reito A, Logren HL, Ahonen K … +2 more , Nurmi H, Paloneva J
Duodecim · 2017 · PMID 29205999
BACKGROUND: The epidemiology of Achilles tendon ruptures and treatment strategies have undergone a major change in recent years. We investigated the incidence of acute Achilles tendon ruptures, the choice of treatment st...
BACKGROUND: The epidemiology of Achilles tendon ruptures and treatment strategies have undergone a major change in recent years. We investigated the incidence of acute Achilles tendon ruptures, the choice of treatment strategies and treatment implementation. MATERIALS AND METHODS: The research material consisted of patients living in the catchment area of Central Finland Hospital District who had been diagnosed with an acute Achilles tendon rupture between 2010 and 2015. RESULTS: The final sample consisted of 266 patients. Conservative treatment was started for 207 patients, and the remaining 59 were referred for surgery. During the study period, the proportion of patients undergoing surgery fell from 41% to 10%. Three patients (1.4%) were referred for surgery during conservative treatment, and 10 patients (4.7%) developed deep vein thrombosis while wearing a cast or an orthosis. Twelve patients (5.8%) sustained a re-rupture after conservative treatment. Two surgically-treated patients (3.5%) sustained a re-rupture, and one patient (1.7%) developed deep vein thrombosis. CONCLUSIONS: The strategies for treating acute Achilles tendon ruptures have clearly become more conservative in our hospital. Conservative treatment is safe and rarely fails. However, it is important to bear in mind that surgery still has a role in the treatment of acute Achilles tendon ruptures.
Who would benefit from exome sequencing?
Saarela J, Kettunen K
Duodecim · 2017 · PMID 29205997
Next-generation sequencing methods have revolutionized the possibilities for analyzing the human genome. Sequencing the exome, the protein-encoding portion of the genome, is used, in clinical medicine, especially in the...
Next-generation sequencing methods have revolutionized the possibilities for analyzing the human genome. Sequencing the exome, the protein-encoding portion of the genome, is used, in clinical medicine, especially in the diagnosis of rare hereditary diseases, congenital developmental disorders and cancer. Using exome sequencing as a diagnostic test is justified when the results could lead to an accurate diagnosis, significantly influence the treatment and genetic counseling. It is a reliable method for detecting single base mutations as minor deletions and insertions. However, with current methods the reliable analysis of larger changes in the number of copies, the length or repeats and areas present in multiple copies in the genome is challenging. Every human has many mutations in their exome, and distinguishing between insignificant and pathogenic mutations is thus a key challenge when interpreting the results of exome sequencing.
Allergic rhinitis.
Numminen J
Duodecim · 2017 · PMID 29205994
There have been no major changes in the pharmacological treatment of allergic rhinitis in recent years. Treatment is symptomatic and tailored individually, taking into account the type and severity of symptoms. Few new p...
There have been no major changes in the pharmacological treatment of allergic rhinitis in recent years. Treatment is symptomatic and tailored individually, taking into account the type and severity of symptoms. Few new products have entered the market, and treatment is still largely based on antihistamines and nasally administered glucocorticoids. However, the general strategies for treating allergic rhinitis have developed over the last decade due to the introduction of the Finnish National Allergy Program. The treatment should aim at improving tolerance. Avoiding allergens is not necessary but it may help in controlling the symptoms. Hyposensitization, the only disease-modifying therapy, is a recommended, effective and safe form of treatment. New, practical sublingual hyposensitization products have facilitated treatment implementation and moved it from outpatient clinics into homes, which is a more patient-oriented approach and also cost-effective in the long term. However, the unit costs of treatment are relatively high for the patients.
Should patients with schizophrenia receive antidepressants?
Terevnikov V, Stenberg JH, Joffe G
Duodecim · 2017 · PMID 29205993
Antipsychotics play a key role in the pharmacological treatment of schizophrenia, and monotherapy is effective for most patients. Achieving an optimal treatment response is, however, often difficult. Combining an antidep...
Antipsychotics play a key role in the pharmacological treatment of schizophrenia, and monotherapy is effective for most patients. Achieving an optimal treatment response is, however, often difficult. Combining an antidepressant drug to the antipsychotic regimen could potentially improve treatment outcomes, although the evidence supporting the use of such combinations is limited and contradictory. Positive evidence has mostly been obtained from the efficacy of antidepressants acting on monoamine receptors on the negative symptoms of schizophrenia. These receptor-active drugs may also improve cognition in schizophrenic patients. In the light of current knowledge, antidepressants do not appear to potentiate the psychotic symptoms of schizophrenic patients. However, there is no robust evidence of the efficacy of antidepressants in the treatment of schizophrenia-related depression, and thus monotherapy with an antipsychotic drug is recommended for treating it. If using antidepressants in addition to antipsychotics is deemed necessary, the risk of pharmacodynamic and pharmacokinetic interactions should be kept in mind.
Cardiac deformation imaging.
Kylmälä M
Duodecim · 2017 · PMID 29205991
Deformation imaging (strain imaging) is an echocardiographic method for evaluating myocardial function that is also suitable for clinical use. There are two deformation imaging techniques: Tissue Doppler and 2D strain (s...
Deformation imaging (strain imaging) is an echocardiographic method for evaluating myocardial function that is also suitable for clinical use. There are two deformation imaging techniques: Tissue Doppler and 2D strain (speckle tracking). Deformation imaging allows the measurement of regional myocardial deformation in three dimensions. Longitudinal deformation (strain) measures longitudinal myocardial fiber contraction, and reflects subendocardial myocardial function, which is usually the first to deteriorate in patients with heart disease. Reduced longitudinal strain can reveal heart disease even when ejection fraction and cardiac contractility appear normal. Deformation imaging can be used for diagnosing ischemia, distinguishing between pathological and physiological hypertrophy, and early detection of heart disease in hypertension or diabetes. Global longitudinal strain (GLS) is an indicator of overall left ventricular systolic function, and correlates with the prognosis better than ejection fraction.
Pericardial drainage and sampling.
Sinisalo J, Gunn J
Duodecim · 2017 · PMID 29205990
Invasive treatment of pericardial effusion comes into question when the volume of liquid in the pericardium limits the pumping action, the cause of effusion is unclear, the response to conservative treatment has been poo...
Invasive treatment of pericardial effusion comes into question when the volume of liquid in the pericardium limits the pumping action, the cause of effusion is unclear, the response to conservative treatment has been poor, or administration of a drug into the pericardium is desired. A number of surgical means or puncture techniques are available for pericardial drainage. We present the indications and modes of treatment for invasive treatment of pericardial effusion. Thrombi, pus or air may also occasionally be present in the pericardium, limiting the heart's pumping action.
Postpericardiotomy syndrome.
Lehto J, Virolainen J
Duodecim · 2017 · PMID 29205989
Postpericardiotomy syndrome (PPS) is a common complication following cardiac surgery. In most cases it develops 2 to 3 weeks after the operation. An inflammatory reaction develops in the pericardium or pleural space with...
Postpericardiotomy syndrome (PPS) is a common complication following cardiac surgery. In most cases it develops 2 to 3 weeks after the operation. An inflammatory reaction develops in the pericardium or pleural space with fever, chest pain and dyspnea as typical symptoms. The disease process is usually self-limiting. At present, the etiology is unknown, but an immunological mechanism is suspected as the cause of the disease. The incidence of PPS is essentially dependent on diagnostic criteria, patient group and type of operation. Treatment is carried out with anti-inflammatory analgesics, combined with colchicine in more severe cases.
Pericardial fluid: assessment and examination.
Turpeinen A, Hedman M
Duodecim · 2017 · PMID 29205988
Pericardial fluid is a common finding on echocardiography. Less than 10 mm of fluid on ultrasound scan is not necessarily associated with any significant illness. Clinical examination, blood count, renal and liver enzyme...
Pericardial fluid is a common finding on echocardiography. Less than 10 mm of fluid on ultrasound scan is not necessarily associated with any significant illness. Clinical examination, blood count, renal and liver enzymes and thyroid function tests as well as inflammatory marker tests are often adequate for a patient who is in good health. A significant amount of fluid requires further investigations, especially in a symptomatic patient. Cancers, infections and various systemic diseases are the most common causes of prominent effusion.
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